Study Highlights Importance of Achieving CR After Intensive Therapy for AML

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Patients with acute myeloid leukemia who achieve complete remission have improved overall survival.
Patients with acute myeloid leukemia who achieve complete remission have improved overall survival.

SAN DIEGO Patients with acute myeloid leukemia (AML) who achieve complete remission have improved overall survival compared with those who achieve complete remission with incomplete marrow recovery, according to a study presented at the American Society of Hematology (ASH) 58th Annual Meeting and Exposition.1

"The results of the E2906 study strongly support the use of intensive therapy for patients aged 60 years or older who are fit for such treatment," said principal investigator James M. Foran, MD, a hematologist at the Mayo Clinic in Jacksonville, Florida. “The risk of induction mortality remains a barrier to curative therapy in older patients with AML.”

To evaluate the importance to achieving complete remission in this patient population and examine risk factors associated with early mortality and a second cycle of induction therapy, researchers analyzed data from the ECOG-E2906 study (ClinicalTrials.gov Identifier: NCT01041703), which assessed clofarabine vs daunorubicin plus cytarabine (standard therapy), followed by decitabine or observation among older patients with newly diagnosed AML.

Researchers found that age (P = .06) and performance status (P = .05) were associated with 30-day induction mortality. Similar results were observed for 60-day induction mortality.

Treatment arm (P = .003), age (P =.02), white blood cell count less than 10,000/μL (P = .03), and cytogenetics (P = .01) were associated with receipt of 2 cycles of induction therapy.

A landmark analysis of quality of remission on overall survival in 608 evaluable patients demonstrated that there was an advantage in achieving complete remission and complete remission with incomplete marrow recovery.

“At longer follow-up, overall survival after complete remission with incomplete marrow recovery appears to be inferior to true complete remission, particularly after clofarabine,” Dr Foran added. “We hypothesize that this may be due to higher rates of minimal residual disease in complete remission with incomplete marrow recovery. Minimal residual disease studies to determine this are being performed.”

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Overall survival after morphologic leukemia-free state appeared similar to that after treatment failure.

“This follow-up analysis confirms the importance of achieving true complete remission in older adults regardless of the number of cycles of induction therapy required to achieve remission,” concluded Dr Foran.

Reference

  1. Foran JM, Sun Z, Claxton DF, et al. Importance of achieving complete remission (CR) after intensive therapy for acute myeloid leukemia (AML) in older adults age ≥60 years: Analysis of risk factors for early mortality and re-induction, and impact of quality of response on overall survival (OS) in the ECOG-ACRIN E2906 randomized trial. Paper presented at: American Society of Hematology (ASH) 58th Annual Meeting and Exposition; December 3-6, 2016; San Diego, CA.

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